New Member Registration Form – St. Francis Xavier Church

Family Last Name*

Phone #*

Unlisted*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Would you like to receive church envelopes or would you like to receive more information about online giving?*

Church Envelopes
Online Giving Options

Marital Status*

Single
Married
Divorced
Widowed

Date of Marriage*

Place of Marriage*

Member Information

Name*

First Last Maiden Name or N/A

Cell Phone #*

Unlisted*

Yes
No

Email*

Date of Birth*

Religion

Baptized Date and Church/City*

Confirmation Date and Church/City*

Occupation

Place of Employment

Phone

Add Another Member*

Yes
No

Additional Member

Name*

First Last Maiden or N/A

Cell Phone#

Unlisted

Yes
No

Email*

Date of Birth*

Religion

Baptized Date and Church/City

Confirmation Date and Church/City

Occupation

Place of Employment

Phone

Children

Need to add Child(ren)?*

Yes
No

(under 21 & living at home)

Child

Name*

M/F

Male
Female

Date of Birth

Baptism (Date/Church)

Confirmation (Date/Church)

Add Another Child?*

Yes
No

Child

Name*

M/F

Male
Female

Date of Birth

Baptism (Date/Church)

Confirmation (Date/Church)

Add Another Child?*

Yes
No

Child

Name*

M/F

Male
Female

Date of Birth

Baptism (Date/Church)

Confirmation (Date/Church)

In Case of Emergency Contact:

Emergency Contact Name*

First Last

Emergency Contact Phone#*

Relationship*

If you are coming to us from another parish, please list the name and be sure to call their office so they may update their records.

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Name

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